HomeMy WebLinkAboutBLD2009-00182 UILDING PERMIT APPLICA BLD09-00182
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Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00182 Received Date: 6/22/2009
SITE ADDRESS: 75 ALDRICH RD
PORT TOWNSEND, 98368
OWNER: DANIEL D HUNTINGFORD PHONE: (360) 385-0339
ANNE L HUNTINGFORD
75 ALDRICH RD
PORT TOWNSEND WA 98368-9613 TUKEY'S ADDITION
SUBDIVISION: Block: 7 Lot: 4+
PARCEL NUMBER: 999200703 Section: 31 Township: 30 N Range: 01 W
CONTRACTOR: HUGHES BUILDING CO PHONE: (360) 774-1504 (CELL)
922 THOMAS ST
PORT TOWNSEND WA 98368
Contractor's License HUGHEBC033CK Expires 11/7/2009
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP CHANGE PITCH OF ROOF ON EXISTING SFR, ADD SKYLIGHTS, ETC
SEE ATTACHED - NOT GOING OUTSIDE FOOTPRINT
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 50,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK. BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 3 Exist: 2
Prop: 0 Prop: 0
Total: 3 Total: 2
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
APPROV El
Total:
JUL Up 2or`
Jefferson County Plannint
&Building Department
•
Jefferson County Building Dion Permit Number: BLD09-00182
Applicant: HUNTINGFORD
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Ext. Shear Wall Nailing
Framing t)011
Airseal
Insulation: Ceiling
Wallboard Nailing R.iat„6 �
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
es C •
JEFFERSON� UNTY
W DEPARTMENT OF COMMUNITY DEVELOPMENT
'+' ` '� 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�`�BIN��p www.co.jefferson.wa.us/commdevelopment n
Master Permit Application MLA: r1 b f Y)L/� K� Q /D
Project Description(include separ to sheets as necessary):
S Q--t_ 12j)
Tax Parcel Number: I CO) 7 0 3 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
75-AIboIf 2eeQ Y.T. //
Property Owner(s)of Record: `� 1Y/ /). k/7�''
Telephone: 9 5--.., 0 977 Fax: g•Gr email:csos€% e/rie 1,0
Mailing Address: (• 1'
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
'l Building / o`f 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]'"""
❑ Manufactured Home .❑ Modular - 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Sign 0 Planned Rurai Residential Development(PRRD)/Amendments**
0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
O Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Y: ' (;_ 7:, ?-- Date: S'— .01` C'j'-
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs, reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applits�tioq that he or she wan prior notice.
Signature: Z iai. =f� �- Date: ‘"W 'd%
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will riot violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable rf spo,/n ib'li or Ting to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: �i t(/Gkj C .. Date: "� le," 7j
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• BUILDER STATEMENT •
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Cc0 .•
‘ei-t-S '4i-,:3 k', (3 SSS-2 �-i ic i (360 - - 1 $�`ct
M �LING ADDRESS: C`.,),)�h tNOCK,l' OCI l7WvLGV✓ Wele( Sratc EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: \Al\ G ._fC.0 32) C-K.-. NUMBER kj\j.,\SJfm \S\Asia t('C -
ARCHITECT/ENGINEER: ��.1pr)T,i.v kI C T t.�.SS2_ PHONE C�bo) 3, ^_ Ens"-FAX:( )
MAILING ADDRESS: � —
c ) .t vi 0.`�,w,�c 5 h J ,\A-),\A c,,A EMAIL vs,w J.../ y/, v A 00-,'Il S l,,(-et In cc r nG . Ce),v,
Project Type: Frame Type: Bathrooms: ° „Z r' L. Shoreline: Type of Sewage Disposal:
❑ New 0 Wood Existing: ❑ Sewer
O Addition ❑ Steel Proposed: Bank ❑ Community System
Alteration/Remodel ❑ Concrete Total: _ Height: 0 Individual System
❑ Repair ❑ Masonry SEP Permit#
O Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: 0 Public
Total: Name of System:
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
i Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove I Cook Stove i Woodstove 1 Fireplace Insert i Hot Water Tank i Pellet Stove 1 Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH BId App Review:
2"0 Floor Heated Consistency Review:
Other Heated Base fee: (p 13. '1 5
Mezzanine Additional Section:
Heated Basement Plan Check fee: 4''01 11
Unheated Basement State Surcharge fee: 4`so
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL O'^io` .,6/
Decks 911/Rd Approach fee: __
Other TOTAL $ l 0(0 l9_ LCI
Receipt Number: I D (053
Cash/Check Number: 1��
ESTIMA D CO REQUIRED) Date: rr �l► ��//;
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